Embolization of varices

Abstract

Variceal embolization once served as a primary tool for the treatment of recurrent or refractory variceal hemorrhage. Despite the use of a variety of techniques and embolic agents, it proved to not be durable because of persistent portal hypertension leading to variceal recanalization or enlargement of untreated varices. The role of embolization returned with the widespread creation of transjugular intrahepatic portosystemic shunts (TIPS). Despite the formation of thousands of TIPS, the optimal indications, techniques, and attributable results of adjunctive esophageal variceaf embolization remain largely based on uncontrolled single-site reports. The specific effect of the embolization is difficult to assess amidst the more powerful effect of reducing a patient's portal pressure with TIPS. It is unclear whether embolization should be performed before tract angioplasty and stent placement, performed routinely after TIPS, or reserved for certain anatomic subsets, such as gastric varices. This article reviews techniques for variceal embolization and the unique anatomic subsets for which embolization should be performed.